Health Chats
GERD/Heartburn: Advances in the Treatment of Severe GERD
Wednesday Apr 07, 2010, 05:00PM - 06:00PM (EST)
Elliot R Goodman, MDBlank
Chief of Bariatric Surgery Service
Beth Israel Medical Center
Surgery, New York, NY
GastroEsophageal Reflux Disease (GERD), also referred to as heartburn, is reflux and regurgitation of the contents of the stomach into the esophagus that is frequent and severe enough to impact daily life and may even damage the esophagus. Normally, after swallowing, a valve between the esophagus and stomach opens to allow food to pass into the stomach, then closes to prevent reflux of the food back into the esophagus. In GERD, this valve is weakened or absent, causing the acidic digestive juices from the stomach to flow back (or reflux) into the esophagus. <br><br> The esophagus is not designed to handle the acidic environment of the stomach. This reflux is not only painful and uncomfortable, but can burn the esophagus, cause chronic inflammation, and can lead to major damage and cancer of the esophagus. GERD is one of the most common diseases, with over 60 million Americans experiencing symptoms at least once a month. For many lifestyle modifications can significantly decrease the occurrence and severity of GERD and are usually the appropriate first step in the treatment process. <br><br> Drug therapies such as proton pump inhibitors (PPI) and H2 (H2RA) blockers reduce ‘typical' GERD symptoms caused by acid exposure, but they are not effective in treating non-acidic or alkaline reflux and ‘atypical symptoms' like asthma, or chronic cough. Even if drug therapy is effective, it may be needed for life, since symptoms and disease return as soon as medication is stopped. Surgery is sometimes indicated for patients with severe GERD who have failed less invasive treatments. Laparoscopic repair has been shown to be effective in 75-90% of patients in alleviating heartburn and 50-75% in alleviating cough, asthma, and laryngitis. Unfortunately, even laparoscopic surgical repair can be invasive and typically has a high incidence of side effects like gas bloat and difficulty swallowing. For this reason, less than 1% of GERD patients currently choose invasive surgical therapy to treat their condition. <br><br> Transoral Incision Free Fundoplication (TIF) is the third wave in the evolution of surgical procedures for the treatment of GERD and builds upon the principles of proven open and laparoscopic procedures used to effectively treat the disease. The key differences are that EsophyX TIF is performed through the mouth, does not require any incisions, and does not dissect any part of the natural internal anatomy. Benefits include reduced recovery time and discomfort and most patients are able to return to work and normal activities within a couple of days after the procedure. <br><br>
Dr. Elliot Goodman:
This is difficult to treat.
Dr. Elliot Goodman:
Some medications such as Reglan may help.
Dr. Elliot Goodman:
Occasionally surgery is indicated, but this is very drastic.
Dr. Elliot Goodman:
It looks like you are doing all the right things, short of surgery
auntiejessi:
I've had GERD for years (I'm 41), and OTC omeprazole isn't working so well anymore.  I don't have insurance, so is there anything else OTC I can take that might work better? I've tried zantac, etc., in the past, and omeprazole had been working best.  Thanks!
Dr. Elliot Goodman:
Based on your description, suggest you try 40 mg. of Omeprazole twice per day.
Dr. Elliot Goodman:
If that does not work perhaps some other PPI's may be useful such as Prevacid.
Dr. Elliot Goodman:
Prevacid is available over-the-counter (OTC)
lovebaby605:
Dr Goodman. I'm a 36 year old female. I had my gall bladder removed 3 years ago and have been suffering from heartburn ever since. Is this a side effect of Cholecystectomy?
Dr. Elliot Goodman:
NO!
Dr. Elliot Goodman:
However, it is possible that the heartburn is complete coincidental.
Dr. Elliot Goodman:
Endoscopy would be a good test to rule this out.
calgal76:
Im on Domperidone and Rabeprazole that doesnt work well. But not sure the doctor diagnosed me correctly. Spices dont bother me, but pop, sweets, juices and milk does. I mostly stay away from those things, but diet pop is a weakness. I'm on Ducosate, Trazodone, Citalopram, Bupropion, and Celebrex. I also take two extra strength Exlax and two Diurex every day and vit D, Omega 3 and a multivit. I'm currently a recovered "Bulimic with Anorexic traits" (since I was 17. Now 33)! I dont like to eat during the day but force myself to have Ensure every morning and eat again in the evening (around 7), which is usually something with spice. I have osteopenia and am on Celebrex thats not working well, so I lay down a lot because of the pain. Could this "GERD" be something else? I've been on things like Ranitidine and others I don't recall. Dr. has brought up a surgery for it but I don't want that. Any idea on all this? Does it sound like GERD or something else? I hope this is all the info you need...
Dr. Elliot Goodman:
Clearly your medical history is very complex and you are on a lot of medications.
Dr. Elliot Goodman:
The best thing you can do is to undergo a full GI evaluation with the appropriate specialist.
Dr. Elliot Goodman:
This could include an endoscopy, a barium swallow, a Ph test and if necessary a manometry
Dr. Elliot Goodman:
to look at your esophageal and stomach funtion.
sk123:
What is Esophyx? Are there potential side effects? Will it cure the acid reflux? What is the recovery time?
Dr. Elliot Goodman:
Esophyx is a device with which a doctor can reconstruct the valve between the esophagus and the stomach.
Dr. Elliot Goodman:
The procedure can help patients with moderate to severe GERD, who have failed PPI's or who are suffering from the side effects of PPI's.
Dr. Elliot Goodman:
It is all done through the mouth with no incisions.  Side effects are less frequent than with laparoscopic surgery
Dr. Elliot Goodman:
(keyhole).
Dr. Elliot Goodman:
Recovery time is 24-48 hours.
Dr. Elliot Goodman:
There is an 80 to 90% success rate.
Aida123:
Does keyhole fundoplication surgery help stop severe regurgitation in a GERD sufferer?
Dr. Elliot Goodman:
This surgery can help the reflux of acid and the reguritation of food in a GERD sufferer.
Dr. Elliot Goodman:
There is however, a 7-10% major complication rate which include:  gas bloating and trouble swallowing.
Dr. Elliot Goodman:
Consider Esophyx a less invasive alternative.
Angel_Faces_Mom:
I take Aciphex in the mornings, but sometimes have  breakthrough acid reflux attacks that wake me up quite violently during sleep.  Is it alright to treat with an OTC like Zantac?  If I feel like it's going to happen, I usually do take a Zantac, then I'm able to go back to sleep in reclined sitting position propped up by pillows.
Dr. Elliot Goodman:
Based on your description, it's OK to add Zantac to Aciphex.
Dr. Elliot Goodman:
Also consider lifestyle changes, for instance avoiding eating late at night.
elora2282:
I have been taking protonix for 5 years now and I still have the same symptoms if I miss a dose. Not sure what to do as I feel I will need to take this pill for the rest of my life, my DR says its a chronic disease and I will probably have this my whole life! Are there any current or future treatments for this? I have an ulcer and GERD